Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery

Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery Adrien Crestani, Marjolaine Le Gac, Amine Bibaoune, Yohann Dabi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2981972/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Aug, 2023 Read the published version in Journal of Robotic Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background The aim of this study was to analyze postoperative consumption of analgesics during hospitalization following colorectal surgery for endometriosis. Methods: We conducted a retrospective study at Tenon University Hospital, Paris, France from February 2019 to December 2021. Results One hundred sixty-two patients underwent colorectal surgery: 89 (55%) by robotic and 73 (45%) by conventional laparoscopy. The type of procedure had an impact on acetaminophen and nefopam consumed per day: consumption for colorectal shaving, discoid resection and segmental resection was, respectively, 2(0.5), 2.1(0.6), 2.4(0.6) g/day (p = 10 − 3), and 25(7), 30(14), 31(11) mg/day (p = 0.03). The total amount of tramadol consumed was greater following robotic surgery compared with conventional laparoscopy (322(222) mg vs 242(292) mg, p = 0.04). We observed a switch in analgesic consumption over the years: tramadol was used by 70% of patients in 2019 but only by 7.1% in 2021 (p < 10 − 3); conversely, ketoprofen was not used in 2019, but was consumed by 57% of patients in 2021 (p < 10 − 3). A history of abdominal surgery (OR = 0.37 (0.16–0.78, p = 0.011) and having surgery in 2020 rather than in 2019 (OR = 0.10 (0.04–0.24, p < 10 − 3 )) and in 2021 than in 2019 (OR = 0.08 (0.03–0.20, p < 10 − 3 )) were the only variables independently associated with the risk of opioid use. Conclusion We found that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in this setting, and that it was possible to rapidly modify in-hospital analgesic consumption modalities by significantly reducing opioid consumption in favor of NSAIDS or Nefopam. Endometriosis colorectal surgery post-operative pain analgesic consumption opioids Figures Figure 1 Introduction Endometriosis is a well-known cause of pelvic pain affecting around 10% of women of reproductive age which represents at least 190 million women worldwide (1). Endometriosis is also a risk factor of infertility, quality of life alteration (1), and chronic consumption of opioid and non-opioid analgesics (2). Women with endometriosis are three times more likely to use opioids for uncontrolled pain than patients without endometriosis (3). Depending on the study, 42% (2) to 62% (4) of patients with endometriosis use opioids. Moreover, in the postoperative period following resection of endometriosis lesions, a threefold increased risk of postoperative opioid consumption has been observed (5) On one hand, there is the risk that exposure to opioids during hospital stay, particularly after surgery, can lead to dependence afterwards (6,7) and, on the other hand, persistent pain in the immediate postoperative period may lead to longer hospital stays, readmission, and longer recovery times (8). Robotic surgery improves the surgeon's vision and facilitates nerve sparing techniques, and had been shown to reduce opioid consumption in benign hysterectomy (9). However, no data are available in the specific context of colorectal resection for endometriosis. Therefore, the aim of this study was to compare postoperative consumption of analgesics during the hospital stay of patients who had undergone colorectal resection for endometriosis by robotic or conventional laparoscopy. Methods We conducted a retrospective cohort study including patients who had undergone colorectal surgery for endometriosis at Tenon University Hospital, Expert Centre in Endometriosis (GRC-6, C3E), Paris, France, from February 2019 (corresponding to the endowment of a robot from our hospital) to December 2021. Institutional review board approval was obtained, and all patients gave their written informed consent to participate in the study (CEROG 2012-GYN-10-03). Patients We included symptomatic patients >18 years of age scheduled for colorectal surgery after failure of medical treatment and/or with infertility. Colorectal endometriosis was assessed by transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI), and rectal echo-endoscopy (REE) using previously published criteria (10–12). The robotic and conventional laparoscopy approaches were exclusively performed depending on the availability of the robotic theatre: none of the patients were allocated to robotic or conventional laparoscopy based on preoperative characteristics. At surgery, the endometriosis stage was evaluated according to the ASRM classification. Bowel endometriosis surgery was performed as previously described (13) and associated procedures including adnexal surgery (ovarian cystectomy or salpingo-oophorectomy), resection of the uterosacral ligament, torus uterinus, or parametrium, partial colpectomy, hysterectomy, ureterolysis, and ureteral reimplantation were performed when required. After surgery, the patients were hospitalized in our gynecological surgery department. Acetaminophen (Sanofi, Paris, France) was systematically administered every 6 hours for the first 24 hours according to our standardized analgesic protocol. Patients with resistant pain were given ketoprofen 50mg (VIATRIS SANTE, Lyon, France) or nefopam ((VIATRIS SANTE, Lyon, France) every 6 hours if the pain was rated at below 7/10 on the visual analogue scale (VAS), or in combination if the pain was rated at over 7/10. Tramadol 50mg (ARROW, Lyon, France) was given if the pain was still resistant. Finally, oral morphine sulfate 10mg (ETHYPHARM, Saint cloud, France) or intravenous morphine chlorhydrate 3mg (LABORATOIRE RENAUDIN, Itxassou, France) was prescribed every 4 hours for patients whose pain remained resistant to these treatments with a VAS above 7/10, with the objective of reducing the score to under 3/10. Data about analgesic consumption was collected through our medical prescription and delivery software: Orbis (Agfa Healthcare, Mortsel, Belgium). Morphine consumption was converted to oral morphine equivalents using the guidelines published by the Centers for Disease Control and Prevention (14). Postoperative complications were classified according to the Clavien-Dindo classification system as minor (grade I-II) or major (grade IIIA and IIIB-IV) 22 (15). Statistical analysis The population was divided into two groups according to the surgical approach, i.e., robotic (robotic group) or conventional (conventional group) laparoscopy. Patients were also categorized according to the type of analgesics they consumed, i.e., opioids or non-opioid analgesics. Univariate analysis was performed using the Student’s t test for normally distributed data and the Chi Square test for categorical data. The Wilcoxon test was used for continuous variables and Fisher’s exact test for categorical variables. All reported p-values were 2-sided. Significant difference was denoted when p<0.05. All statistical analysis was performed using commercially available software (RStudio Team (2020). RStudio: Integrated Development for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com). Results Epidemiologic characteristics and surgical findings The study population was composed of 162 patients undergoing colorectal surgery for bowel endometriosis between February 2019 and December 2021. Eighty-nine patients (55%) underwent robotic laparoscopy (robotic group), and seventy-three (45%) conventional laparoscopy (conventional group). For 142 patients (142/162, 87%), pain was part of the surgical indication. The epidemiological characteristics of the population are depicted in Table 1. Table 1: Characteristics of the study population Characteristic N = 162 Age (years) mean (SD) 35.65 (6.78) BMI (kg.m -2 ) mean (SD) 24.95 (6.07) Parity 0 108 (67%) 1 24 (15%) >2 30 (18%) Year of the surgery: 2019 71 (44%) 2020 49 (30%) 2021 42 (26%) History of abdominal surgery 82 (51%) History of endometriosis surgery 48 (30%) Infertility 71 (44%) Indication for surgery: Pain 85(52%) Infertility 20 (12%) Pain and infertility 57 (35%) BMI, body mass index; SD, standard deviation *Statistics for continuous variable are presented by mean (SD) At surgery, 137/162 (86%) patients had ASMR grade III-IV endometriosis. There was no difference in the ASRM score or the digestive procedure (rectal shaving, discoid, or segmental resection) between the robotic and conventional groups. Similarly, surgical procedures associated with colorectal resection did not differ between the groups except for a higher frequency of JJ stents use in the conventional group compared with the robotic group: 16% (12/73) versus 4.5% (4/89), p=0.011. Finally, the operating time was longer for the robotic group: 200 versus 251 minutes (p=0.003). Table 2 presents the surgical findings for both groups. Table 2: Surgical Findings according to the surgical approach Variable Overall , N = 162 Conventional laparoscopy, N=73 Robotic laparoscopy, N = 89 p-value ASRM score 29 (18) 27 (17) 31 (18) NS Operating time (minutes) 232 (83) 210 (73) 250 (86) 0.003 Bowel endometriosis resection - Shaving 46 (28%) 23 (32%) 23 (26%) NS - Discoid 58 (36%) 21 (29%) 37 (42%) 0.09 - Segmental 58 (36%) 29 (40%) 29 (33%) NS Hysterectomy 49 (30%) 25 (34%) 24 (27%) NS Colpectomy 39 (24%) 17 (23%) 22 (25%) NS Endometrioma surgery 29 (18%) 13 (18%) 16 (18%) NS Ureteral or bladder resection 6 (3.7%) 2 (2.7%) 4 (4.5%) NS Temporary diverting stoma 22 (14%) 14 (19%) 8 (9.0%) 0.060 Peroperative JJ stents 16 (9.9%) 12 (16%) 4 (4.5%) 0.011 Drainage 117 (72%) 51 (70%) 66 (74%) NS Hospital stay (days) 7 (4, 8) 7 (4, 9) 6 (4, 8) NS 10 24 (15%) 12 (16%) 12 (13%) NS ASRM, American society of reproductive medicine; SD, standard deviation *Statistics for continuous variable are presented by mean (SD) During hospitalization, 39 patients (39/162, 24%) experienced a complication. Of these, 11/39 (28%) were Clavien-Dindo classification grade I, 18/39 (46%) were grade II, 5/39 (13%) were grade IIIA, 3/39 (8%) grade IIIB, and 2/39 (5%) were grade IV. The general characteristics of the subgroup of patients that experienced a complication was comparable to those who did not. However, in terms of surgical findings, the patients that experienced a postoperative complication had more colpectomy (15/39 vs 24/123, p=0.016), temporary diverting stomas (9/39 vs 13/123, p=0.047), and drainage (34/39 vs 83/123, p=0.017). These patients also had a longer hospital stay (p<10 -3 ). Analgesic consumption Acetaminophen was the most frequent analgesic consumed during hospitalization (158/162, 98%) with a mean (SD) of 2.2 (0.6) g/day for 5.2 (3) days on average. The four patients who did not take acetaminophen also refused all other analgesics during their hospitalization. Ketoprofen was used by 38/162 (23%) patients with a mean (SD) of 83 (32) mg/day for 3.1 (1.9) days on average. Nefopam was used by 98/162 (60%) patients with a mean (SD) of 29 (11) mg/day for 2.5 (1.6) days on average. Tramadol was used by 58/162 (36%) patients with a mean (SD) of 82 (40) mg/day for 3.2 (2.1) days on average. Morphine was used by 16/162 (9.9%) patients with a mean (SD) of 13 (6) MME/day for 2.1 (2.5) days on average. Table 3 presents the modalities of analgesic consumption according to the postoperative complication. Table 3: Analgesic consumption in patients with or without postoperative complications. Immediate postoperative complication No, N = 123 Yes, N = 39 p-value Acetaminophen 119 (97%) 39 (100%) NS - duration of use (days) 4.5 (2.4) 7.4 (3.8) <0.001 - total intake per day (g/day) 2.1 (0.6) 2.3 (0.6) NS - total intake (g) 10 (6) 18 (12) <0.001 Ketoprofen 28 (23%) 10 (26%) NS - duration of use (days) 2.9 (1.9) 3.4 (1.8) NS - total intake per day (mg/day) 78 (30) 97 (35) NS - total intake (mg) 248 (210) 378 (279) NS Nefopam 71 (58%) 27 (69%) NS - duration of use (days) 2.4 (1.6) 2.9 (1.6) 0.044 - total intake per day (mg/day) 28 (11) 31 (12) NS - total intake (mg) 69 (59) 99 (74) 0.036 Tramadol 43 (35%) 15 (38%) NS - duration of use (days) 2.9 (1.9) 4 (2.5) NS - total intake per day (mg/day) 82 (40) 83 (41) NS - total intake (mg) 259 (248) 353 (284) NS Morphine 9 (7.3%) 7 (18%) 0.066 - duration of use (days) 1.4 (1) 2.9 (3. 7) NS - total intake per day (MME/day) 12 (6) 14 (7) NS - total intake (MME) 20 (21) 53 (87) NS *Statistics for continuous variable are presented by mean (SD) MME, Morphine milligram equivalent; NS, not significant The bowel procedure had an impact on the quantity of acetaminophen consumed per day with 2 (0.5) g/day for colorectal shaving, 2.1 (0.6) for discoid resection, and 2.4 (0.6) for segmental resection (p=10­ -3 ). It also impacted the consumption of nefopam with, respectively, 25 (7), 30 (14), and 31 (11) mg per day (p=0.03). On the other hand, no impact on ketoprofen (p=0.6), tramadol (p=0.5) or morphine (p=0.6) use was noted between patients with and without postoperative complications. Table 4 shows the consumption of analgesics for the robotic and conventional groups. Among the tramadol users, more tramadol was consumed in the robotic group than in the conventional group (322 (222) mg vs 242 (292) mg, p=0.04)), with a tendency for longer use in the robotic group (3.7 (2.2) vs 2.7 (1.9) days, p=0.08)). There was no difference in the average daily dose received (p=0.2). Table 4: Analgesic consumption in patients depending on the surgical route. Surgical route Standard Laparoscopy, Robotic surgery, p-value N = 73 N = 89 Acetaminophen 72 (99%) 86 (97%) NS - duration of use (days) 5.1 (2.7) 5.2 (3.3) NS - total intake per day (g/day) 2.1 (0.6) 2.2 (0.6) NS - total intake (g) 11 (7) 12 (10) NS Ketoprofen 16 (22%) 22 (25%) NS - duration of use (days) 3.5 (2.1) 2.8 (1.7) NS - total intake per day (mg/day) 89 (33) 79 (32) NS - total intake (mg) 346 (288) 243 (188) NS Nefopam 39 (53%) 59 (66%) NS - duration of use (days) 2.8 (1.7) 2.3 (1.5) NS - total intake per day (mg/day) 31 (13) 28 (10) NS - total intake (mg) 88 (74) 69 (57) NS Tramadol 28 (38%) 30 (34%) NS - duration of use (days) 2.7 (1.9) 3.7 (2.2) 0.08 - total intake per day (mg/day) 78 (41) 86 (39) NS - total intake (mg) 242 (292) 322 (222) 0.04 Morphine 8 (11%) 8 (9.0%) NS - duration of use (days) 1.7 (1.2) 2.4 (3.5) NS - total intake per day (MME/day) 14 (6) 11.7 (7) NS - total intake (MME) 27 (24) 42 (83) NS *Statistics for continuous variable are presented by mean (SD) MME, Morphine milligram equivalent; NS, not significant Analgesic consumption varied significantly according to the year of surgery. Figure 1 shows the changes in consumption of the different analgesics according to the year. Patients consuming ketoprofen were more likely to use nefopam and tramadol (p=10 -3 ), whereas patients consuming tramadol were more likely to use morphine (p=0.02). Factors associated with an increased risk of opioid use Univariable and multivariable linear regression analysis of the consumption of any opioid is presented in Table 5. A history of abdominal surgery (OR=0.37 (0.16-0.78, p=0.011)), and undergoing surgery in 2020 rather than in 2019 (OR=0.10 (0.04-0.24, p<10 -3 )), and in 2021 rather than in 2019 (OR= 0.08 (0.03-0.20, p<10 -3 )) were the only variables independently associated with the risk of opioid use after colorectal surgery for endometriosis. Table 5: Univariable and multivariable analysis on the consumption of any opioid Opioid consumption No Yes OR (univariable) OR (multivariable) Age (years) 35.8 (6.9) 35.5 (6.6) 0.99 (0.95-1.04, p=0.81) BMI (kg.m -2 ) 25.0 (6.2) 24.9 (5.9) 1.00 (0.94-1.05, p=0.91) History of abdominal surgery 52 (63.4) 30 (36.6) 0.55 (0.29-1.02, p=0.06) 0.37 (0.16-0.78, p=0.01) Year of surgery 20 (28.2) 51 (71.8) - - -2019 -2020 38 (77.6) 11 (22.4) 0.11 (0.05-0.26, p<0.001) 0.10 (0.04-0.24, p<0.001) -2021 33 (78.6) 9 (21.4) 0.11 (0.04-0.25, p<0.001) 0.08 (0.03-0.20, p<0.001) Robotic surgery 51 (57.3) 38 (42.7) 0.90 (0.48-1.69, p=0.75) ASRM score 30.3 (16.3) 28.1 (19.0) 0.99 (0.97-1.01, p=0.43) Colorectal endometriosis surgery 27 (58.7) 19 (41.3) - - Shaving - Discoid 34 (58.6) 24 (41.4) 1.00 (0.46-2.21, p=0.99) - Segmental 30 (51.7) 28 (48.3) 1.33 (0.61-2.92, p=0.48) Operative time (min) 231.4 (82.3) 231.6 (84.1) 1.00 (1.00-1.00, p=0.99) Suprapubic laparotomy 29 (52.7) 26 (47.3) 0.81 (0.42-1.56, p=0.53) Immediate postoperative complications 18 (50.9) 21 (49.1) 1.70 (0.83-3.55, p=0.15) NS ASRM, American society of reproductive medicine; SD, standard deviation; BMI, body mass index *Statistics for continuous variable are presented by mean (SD) Discussion The objective of this study was to present the postoperative analgesic consumption of patients operated on in an expert center for colorectal endometriosis. We observed that surgical procedure did not impact opioid consumption. However, during the period a shift in analgesic use was note with an increased consumption of anti-inflammatory drugs and nefopam while tramadol consumption was divided by 10 in 3 years. To the best of our knowledge, this is the first study to evaluate the modalities of consumption of postoperative analgesics in a large cohort of women operated on for colorectal endometriosis. As previously described, this is a challenging setting because colorectal endometriosis represents the most severe form of endometriosis and is the source of the most severe postoperative complications (16,17). Our complication rate is in agreement with previous reports: 13% of Clavien-Dindo grade IIIA, 8% grade IIIB, and 5% of grade IV (18). This relatively high complication rate can be explained by the incidence of some surgical risk factors such as a high rate of colpectomy, temporary diverting stoma, intra-operative JJ stent use, and ureteral or bladder resection (19,20). Moreover, as previously published for bowel cancer surgery, the high incidence of drainage in our series was associated with a risk of postoperative complications underlining the need to avoid systematic drainage (21,22). In our study, the surgical approach –robotic or conventional laparoscopy– had no impact on the likelihood of being exposed to an opioid during hospitalization. However, in patients using tramadol preoperatively, robotic surgery increased the total amount consumed linked to longer postoperative use. Our results are partially in agreement with those of previous studies showing no difference in analgesic consumption between robotic vs conventional laparoscopy (9). However, our data contrast with the results of Mangalath et al (23) reporting lower analgesic use during the first postoperative 24 hours following robotic surgery. This apparent discrepancy can be explained by the limited sample size of Mangalath et al’s study which only included 24 patients in the robotic group, after exclusion of four, and 24 patients in the laparoscopic group, after exclusion of 37. Beyond the surgical approach, postoperative analgesic consumption should be analyzed in the specific context of endometriosis. Time-to-diagnosis for patients with endometriosis can be as long as 12 years during which time they often experience considerable pain (1). They have often been subjected to medical wandering and multiple surgeries, and can suffer from anxiety and depressive disorders (24), all of which have a negative impact on social and familial relationships as well as causing stigma. This explains the high preoperative incidence of analgesic consumption in this population (25). Our data focus on the in-hospital postoperative period and only on drugs that were both prescribed and actually taken by the patients. The first 2 days after colorectal surgery are the most painful (26), and this therefore represents a crucial moment for analgesic consumption: the likelihood of chronic opioid use increases with each additional day of medication supplied starting with the third day after surgery (27). In our study, the average duration was 2.06 days (2.09) for morphine consumption and 3.22 (2.09) days for tramadol for a mean hospital stay of 1 week. This means that very few patients were using opioids by the end of their hospital stay, and that there is no need to prescribe them at discharge. This study also showed that it was possible to radically change the prescription habits of all the practitioners working in our center. The example of tramadol is the most striking. Tramadol is a strong contributor to the risk of future opioid addiction (27) and was the first opioid analgesic cited in a 2018 survey of problematic use both among substance abusers and in the general population for pain management conducted by the French National Drug Safety Agency and published in February 2019 (28). Problematic use included dependence with signs of withdrawal occurring even when taken at recommended doses and over a short period of time, and leading to persistent intake by patients who no longer experience pain. The report highlighted that tramadol was also the first analgesic involved in deaths related to the use of analgesics, ahead of morphine. Following this report and recommendations to restrict the indications for tramadol prescription, we have been able to divide its consumption in our hospital by a factor of 10 in 3 years. Opioid treatments have been replaced by the non-steroid anti-inflammatory drugs (NSAID) ketoprofen and nefopam. By 2021, two out of three patients were receiving ketoprofen in postoperative care and three out of four nefopam. Nefopam has been shown to be effective postoperatively (29) and to reduce opioid consumption when combined with an NSAID (30). NSAIDs should be the weapon of choice in postoperative prescriptions: they are effective postoperatively and reduce opioid consumption (31), but they also reduce the rate of fistulas after colorectal surgery (32,33) and shorten the time required to resume transit (34,35). However, as we have seen, there is still room for improvement to increase the prescription of NSAIDs during the postoperative in-hospital period in our department. In our study, in addition to the year of surgery, prior surgery was also found to represent a risk of opioid consumption. This is probably because the patient was exposed to opioids during their previous hospitalization and wishes to benefit from their analgesic effects again. Special attention should thus be paid to patients with a history of surgery, as can often be the case in endometriosis. Finally, although neither the digestive procedure performed nor on the severity of the disease impact postoperative opioid consumption, preoperative consumption has been shown to be a major factor in its use postoperatively (36). This is the main limitation of the study: we did not collect the patients' preoperative consumption habits and a future study will have to take this bias into account. Similarly, we did not collect data about the duration and type of analgesics used after hospitalization, which is important information regarding the risk of chronic opioid use. Finally, the retrospective nature of the data always represents a bias although we used a software dedicated to the prescription of analgesics allowing a comprehensive evaluation of drug consumption. Conclusion In conclusion, our study presents rare data on the immediate postoperative consumption of patients having undergone surgery for colorectal endometriosis. We were able to demonstrate that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in these patients. Furthermore, our study shows that it is possible to rapidly modify in-hospital analgesic consumption by significantly reducing opioid consumption in favor of NSAIDs or nefopam. Declarations Funding: No funds, grants, or other support was received. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose. Consent to participate: Informed consent was obtained from all individual participants included in the study Author Contributions: Amine Bibaoune, Marjolaine Le Gac and Yohann Dabi participated in the data collection, Adrien Crestani carried out the statistics; Kamila Kolanska, Clément Ferrier and Sofiane Bendifallah participated in the writing of the article; Emile Darai validated the final version. Each author ead the manuscript and approved its submission. Consent to participate: Information consent was obtained from all individual participants included in the study Funding: No funds, grants, or other support was received. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose. References Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020;382(13):1244–56. Weaver J, Chakladar S, Mirchandani K, Liu Z. Surgical and Pharmacological Treatment Patterns in Women with Endometriosis: A Descriptive Analysis of Insurance Claims. J Womens Health (Larchmt) 2022;31(7):1003–11. Lamvu G, Soliman AM, Manthena SR, Gordon K, Knight J, Taylor HS. Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines. Obstet Gynecol 2019;133(6):1120–30. As-Sanie S, Soliman AM, Evans K, Erpelding N, Lanier RK, Katz NP. Short-acting and Long-acting Opioids Utilization among Women Diagnosed with Endometriosis in the United States: A Population-based Claims Study. Journal of Minimally Invasive Gynecology 2021;28(2):297-306.e2. Zhang W, Miller V, Wong M, Loring M, Morris S. Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy. JSLS 2022;26(3):e2022.00028. Delgado SI, Koythong T, Turrentine MA, Sangi-Haghpeykar H, Guan X. Postoperative opioid use for patients with chronic pelvic pain undergoing robotic surgery for resection of endometriosis. J Robotic Surg 2022;16(2):421–7. Hill MV, McMahon ML, Stucke RS, Barth RJJ. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Annals of Surgery 2017;265(4):709–14. Lovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surgical Clinics of North America 2015;95(2):301–18. Moawad GN, Klebanoff JS, Muldoon O, North A, Amdur R, Tyan P. Patterns of narcotic utilization in women undergoing hysterectomy for benign indications. Journal of Gynecology Obstetrics and Human Reproduction 2021;50(9):102181. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 2004;232(2):379–89. Roseau G. Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis. World J Gastrointest Endosc 2014;6(11):525–33. Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004;24(2):180–5. Daraï E, Ballester M, Chereau E, Coutant C, Rouzier R, Wafo E. Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis. Surg Endosc 2010;24(12):3060–7. Calculating Total Daily Dose of Opioids For Safer Dosage. :2. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–96. Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018;33(7):835–47. Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021;28(3):453–66. Ferrier C, Le Gac M, Kolanska K, Boudy A-S, Dabi Y, Touboul C, et al. Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: A prospective cohort study. Int J Med Robot 2022;18(3):e2382. Zilberman S, Ballester M, Touboul C, Chéreau E, Sèbe P, Bazot M, et al. Partial Colpectomy is a Risk Factor for Urologic Complications of Colorectal Resection for Endometriosis. Journal of Minimally Invasive Gynecology 2013;20(1):49–55. Ballester M, Belghiti J, Zilberman S, Thomin A, Bonneau C, Bazot M, et al. Surgical and clinical impact of extraserosal pelvic fascia removal in segmental colorectal resection for endometriosis. J Minim Invasive Gynecol 2014;21(6):1041–8. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 2019;43(3):659–95. Podda M, Saverio SD, Davies RJ, Atzeni J, Balestra F, Virdis F, et al. Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials. The American Journal of Surgery 2020;219(1):164–74. Mangalath AS, Kumar L, Sawant AB, Kesavan R, Ravindran G, Sunil R. Comparison of analgesic requirements in robot-assisted versus conventional laparoscopic abdominal surgeries. J Anaesthesiol Clin Pharmacol 2021;37(1):79–84. Jin J, Chen Q, Min S, Du X, Zhang D, Qin P. Prevalence and predictors of chronic postsurgical pain after colorectal surgery: A prospective study. Colorectal Disease 2021;23(7):1878–89. Laganà AS, Rosa VLL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B, et al. Anxiety and depression in patients with endometriosis: impact and management challenges. IJWH 2017;9:323–30. Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis 2020;35(7):1265–72. Shah A. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep [Internet] 2017 [cited 2022 Dec 10];66. Available from: https://www.facebook.com/CDCMMWR Use and abuse of opioid analgesics - February 2019. :52. Evans MS, Lysakowski C, Tramèr MR. Nefopam for the prevention of postoperative pain: quantitative systematic review. British Journal of Anaesthesia 2008;101(5):610–7. Moffat AC, Kenny GN, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery. Anaesthesia 1990;45(4):302–5. Wick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg 2017;152(7):691–7. Grahn O, Lundin M, Chapman SJ, Rutegård J, Matthiessen P, Rutegård M. Postoperative nonsteroidal anti-inflammatory drugs in relation to recurrence, survival and anastomotic leakage after surgery for colorectal cancer. Colorectal Disease 2022;24(8):933–42. Kverneng Hultberg D, Angenete E, Lydrup M-L, Rutegård J, Matthiessen P, Rutegård M. Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer. Eur J Surg Oncol 2017;43(10):1908–14. Milne TGE, Jaung R, O’Grady G, Bissett IP. Nonsteroidal anti-inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2018;20(8):O190–8. Gupta A, Bah M. NSAIDs in the Treatment of Postoperative Pain. Curr Pain Headache Rep 2016;20(11):62. Kanellos P, Nirgianakis K, Siegenthaler F, Vetter C, Mueller MD, Imboden S. Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis. J Clin Med 2021;10(20):4727. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Aug, 2023 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Major revision 09 Jul, 2023 Reviews received at journal 09 Jul, 2023 Reviewers agreed at journal 25 Jun, 2023 Reviewers agreed at journal 04 Jun, 2023 Reviewers agreed at journal 01 Jun, 2023 Reviewers invited by journal 01 Jun, 2023 Editor assigned by journal 28 May, 2023 Submission checks completed at journal 26 May, 2023 First submitted to journal 25 May, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2981972","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":204093011,"identity":"e3d3b4bb-65ff-4318-966e-dfc160695b8f","order_by":0,"name":"Adrien Crestani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIie3OsUvDQBTH8ScHnRJuvVKx/8JzUYsl/isJB9mqARen4nQOUro2/0UhUBwvBHSJZo1kUQRdKy6VKphHhzr0Qt0c7rvdgw+/A7DZ/mU+6PUD+/7qGAHfgjAioQ8tOiK0LxsIrAlkKwINhF8NnvX7jXfGeZF+RFFxyrvXwfwJQRwajMjfMI1z2YsnknUmWJ23lZuI+mNiV28mUIaQuUojlgw6DlbB9NadEhkKg+gS+a7JSZGxpYMPRJIFrZgIEtmhFZCtekUTmYkmsp+/QjpSEkUpD44dlEGsBrMjH4WR7N2FbP6pPOTj9KVyvrxgzO6Tx8VF30iM/RnYbDab7Vc/dt9Y0PZpLGQAAAAASUVORK5CYII=","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":true,"prefix":"","firstName":"Adrien","middleName":"","lastName":"Crestani","suffix":""},{"id":204093014,"identity":"a50e43d8-504e-45eb-9360-15a4e3fbba6d","order_by":1,"name":"Marjolaine Le Gac","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Marjolaine","middleName":"Le","lastName":"Gac","suffix":""},{"id":204093015,"identity":"f8c9c795-1bef-47dc-8c07-e419e3e6da64","order_by":2,"name":"Amine Bibaoune","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Amine","middleName":"","lastName":"Bibaoune","suffix":""},{"id":204093018,"identity":"04ac33a4-59a4-48b3-b2d7-b3d21362425a","order_by":3,"name":"Yohann Dabi","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Yohann","middleName":"","lastName":"Dabi","suffix":""},{"id":204093019,"identity":"6db10367-702f-451c-b074-693fe3e62bef","order_by":4,"name":"Kamila Kolanska","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Kamila","middleName":"","lastName":"Kolanska","suffix":""},{"id":204093020,"identity":"4f61a348-694f-491f-9458-14c2eec1ca37","order_by":5,"name":"Clément Ferrier","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Clément","middleName":"","lastName":"Ferrier","suffix":""},{"id":204093021,"identity":"2ac42c60-6e5b-4fef-b07d-6f6367547a6a","order_by":6,"name":"Sofiane Bendifallah","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Sofiane","middleName":"","lastName":"Bendifallah","suffix":""},{"id":204093022,"identity":"c76de423-8575-4bd2-acef-979b4012ee7b","order_by":7,"name":"Cyril Touboul","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Cyril","middleName":"","lastName":"Touboul","suffix":""},{"id":204093023,"identity":"0040f6e2-c6cd-458c-95b2-108161ef6dba","order_by":8,"name":"Emile Darai","email":"","orcid":"","institution":"Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Emile","middleName":"","lastName":"Darai","suffix":""}],"badges":[],"createdAt":"2023-05-25 15:29:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2981972/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2981972/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-023-01691-y","type":"published","date":"2023-08-22T15:02:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":37668246,"identity":"b401df16-e4b0-4188-91b4-530c3b7ebb46","added_by":"auto","created_at":"2023-05-30 14:53:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8052,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of patients using each analgesic per year of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAccording to the year, there was no difference for acetaminophen use, while tramadol was used by 70% of the patients in 2019 but only 7.1% in 2021 (p\u0026lt;10\u003c/em\u003e\u003csup\u003e\u003cem\u003e-3\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e). Conversely, ketoprofen was not used in 2019, and was consumed by 57% of the patients in 2021 (p\u0026lt;10\u003c/em\u003e\u003csup\u003e\u003cem\u003e-3\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2981972/v1/87710bf7ad4f8815dea5a728.png"},{"id":42781147,"identity":"73e9c509-b813-4d67-a1ae-a43bcd6d8eac","added_by":"auto","created_at":"2023-09-07 15:08:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":376665,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2981972/v1/115a2f15-a8cb-4053-a564-c5ef08ceb1f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis is a well-known cause of pelvic pain affecting around 10% of women of reproductive age which represents at least 190 million women worldwide (1). Endometriosis is also a risk factor of infertility, quality of life alteration (1), and chronic consumption of opioid and non-opioid analgesics (2). \u003c/p\u003e\n\u003cp\u003eWomen with endometriosis are three times more likely to use opioids for uncontrolled pain than patients without endometriosis (3). Depending on the study, 42% (2) to 62% (4) of patients with endometriosis use opioids. Moreover, in the postoperative period following resection of endometriosis lesions, a threefold increased risk of postoperative opioid consumption has been observed (5) \u003c/p\u003e\n\u003cp\u003eOn one hand, there is the risk that exposure to opioids during hospital stay, particularly after surgery, can lead to dependence afterwards (6,7) and, on the other hand, persistent pain in the immediate postoperative period may lead to longer hospital stays, readmission, and longer recovery times (8). Robotic surgery improves the surgeon\u0026apos;s vision and facilitates nerve sparing techniques, and had been shown to reduce opioid consumption in benign hysterectomy (9). However, no data are available in the specific context of colorectal resection for endometriosis.\u003c/p\u003e\n\u003cp\u003eTherefore, the aim of this study was to compare postoperative consumption of analgesics during the hospital stay of patients who had undergone colorectal resection for endometriosis by robotic or conventional laparoscopy. \u003c/p\u003e"},{"header":"Methods ","content":"\u003cp\u003eWe conducted a retrospective cohort study including patients who had undergone colorectal surgery for endometriosis at Tenon University Hospital, Expert Centre in Endometriosis (GRC-6, C3E), Paris, France, from February 2019 (corresponding to the endowment of a robot from our hospital) to December 2021. Institutional review board approval was obtained, and all patients gave their written informed consent to participate in the study (CEROG 2012-GYN-10-03).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatients\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe included symptomatic patients \u0026gt;18 years of age scheduled for colorectal surgery \u0026nbsp;after failure of medical treatment and/or with infertility. Colorectal endometriosis was assessed by transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI), and rectal echo-endoscopy (REE) using previously published criteria (10\u0026ndash;12). The robotic and conventional laparoscopy approaches were exclusively performed depending on the availability of the robotic theatre: none of the patients were allocated to robotic or conventional laparoscopy based on preoperative characteristics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt surgery, the endometriosis stage was evaluated according to the ASRM classification. Bowel\u0026nbsp;endometriosis surgery was performed as previously described\u0026nbsp;(13)\u0026nbsp;and associated procedures including adnexal surgery (ovarian cystectomy or salpingo-oophorectomy), resection of the uterosacral ligament, torus uterinus, or parametrium, partial colpectomy, hysterectomy, ureterolysis, and ureteral reimplantation were performed when required.\u003c/p\u003e\n\u003cp\u003eAfter surgery, the patients were hospitalized in our gynecological surgery department. Acetaminophen (Sanofi, Paris, France) was systematically administered every 6 hours for the first 24 hours according to our standardized analgesic protocol. Patients with resistant pain were given ketoprofen 50mg (VIATRIS SANTE, Lyon, France) or nefopam ((VIATRIS SANTE, Lyon, France) every 6 hours if the pain was rated at below 7/10 on the visual analogue scale (VAS), or in combination if the pain was rated at over 7/10. Tramadol 50mg (ARROW, Lyon, France) was given if the pain was still resistant. Finally, oral morphine sulfate 10mg (ETHYPHARM, Saint cloud, France) or intravenous morphine chlorhydrate 3mg (LABORATOIRE RENAUDIN, Itxassou, France) was prescribed every 4 hours for patients whose pain remained resistant to these treatments with a VAS above 7/10, with the objective of reducing the score to under 3/10. \u0026nbsp;Data about analgesic consumption was collected through our medical prescription and delivery software: Orbis (Agfa Healthcare, Mortsel, Belgium). Morphine consumption was converted to oral morphine equivalents using the guidelines published by the Centers for Disease Control and Prevention (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperative complications were classified according to the Clavien-Dindo classification system as minor (grade I-II) or major (grade IIIA and IIIB-IV) 22\u0026nbsp;(15).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe population was divided into two groups according to the surgical approach, i.e., robotic (robotic group) or conventional (conventional group) laparoscopy. Patients were also categorized according to the type of analgesics they consumed, i.e., opioids or non-opioid analgesics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnivariate analysis was performed using the Student\u0026rsquo;s t test for normally distributed data and the Chi Square test for categorical data. The Wilcoxon test was used for continuous variables and Fisher\u0026rsquo;s exact test for categorical variables. All reported p-values were 2-sided. Significant difference was denoted when p\u0026lt;0.05. \u0026nbsp;All statistical analysis was performed using commercially available software (RStudio Team (2020). RStudio: Integrated Development for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eEpidemiologic characteristics and surgical findings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study population was composed of 162 patients undergoing colorectal surgery for bowel endometriosis between February 2019\u0026nbsp;and December 2021. Eighty-nine patients (55%) underwent robotic laparoscopy (robotic group), and seventy-three (45%) conventional laparoscopy (conventional group). For 142 patients (142/162, 87%), pain was part of the surgical indication. The epidemiological characteristics of the population are depicted in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1: Characteristics of the study population\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"248\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 162\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eAge (years) mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e35.65 (6.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eBMI (kg.m\u003csup\u003e-2\u003c/sup\u003e) mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e24.95 (6.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e108 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e24 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e\u0026gt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e30 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eYear of the surgery:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e71 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e49 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e42 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eHistory of abdominal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e82 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eHistory of endometriosis surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e48 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eInfertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e71 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eIndication for surgery:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e85(52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003eInfertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e20 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.7258064516129%\"\u003e\n \u003cp\u003ePain and infertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.274193548387096%\"\u003e\n \u003cp\u003e57 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index; SD, standard deviation\u003c/p\u003e\n\u003cp\u003e*Statistics for continuous variable are presented by mean (SD)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt surgery, 137/162 (86%) patients had ASMR grade III-IV endometriosis. There was no difference in the ASRM score or the digestive procedure (rectal shaving, discoid, or segmental resection) between the robotic and conventional groups. Similarly, surgical procedures associated with colorectal resection did not differ between the groups except for a higher frequency of JJ stents use in the conventional group compared with the robotic group: 16% (12/73) versus 4.5% (4/89), p=0.011. Finally, the operating time was longer for the robotic group: 200 versus 251 minutes (p=0.003). Table 2 presents the surgical findings for both groups. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Surgical Findings according to the surgical approach\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N = 162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003eConventional laparoscopy, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N=73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003eRobotic laparoscopy, \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;N = 89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASRM score\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e29 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e27 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e31 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperating time (minutes)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e232 (83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e210 (73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e250 (86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBowel endometriosis resection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e- Shaving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e46 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e23 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e23 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e- Discoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e58 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e21 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e37 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e- Segmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e58 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e29 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e29 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHysterectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e49 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e25 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e24 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eColpectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e39 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e17 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e22 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometrioma surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e29 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e13 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e16 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUreteral or bladder resection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e6 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e2 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e4 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporary diverting stoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e22 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e14 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e8 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeroperative JJ stents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e16 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e12 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e4 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrainage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e117 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e51 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e66 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e7 (4, 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e7 (4, 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e6 (4, 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e45 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e19 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e26 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e[5-10]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e93 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e42 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e51 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" style=\"width: 25.8467%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.755102040816327%\" style=\"width: 13.1907%;\"\u003e\n \u003cp\u003e24 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.081632653061224%\" style=\"width: 29.9465%;\"\u003e\n \u003cp\u003e12 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.639455782312925%\" style=\"width: 24.4207%;\"\u003e\n \u003cp\u003e12 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.523809523809524%\" style=\"width: 6.5954%;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eASRM, American society of reproductive medicine; SD, standard deviation\u003c/p\u003e\n\u003cp\u003e*Statistics for continuous variable are presented by mean (SD)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring hospitalization, 39 patients (39/162, 24%) experienced a complication. Of these, 11/39 (28%) were Clavien-Dindo classification grade I, 18/39 (46%) were grade II, 5/39 (13%) were grade IIIA, 3/39 (8%) grade IIIB, and 2/39 (5%) were grade IV. \u0026nbsp;The general characteristics of the subgroup of patients that experienced a complication was comparable to those who did not. However, in terms of surgical findings, the patients that experienced a postoperative complication had more colpectomy (15/39 vs 24/123, p=0.016), temporary diverting stomas (9/39 vs 13/123, p=0.047), and drainage (34/39 vs 83/123, p=0.017). These patients also had a longer hospital stay (p\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalgesic consumption\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAcetaminophen was the most frequent analgesic consumed during hospitalization (158/162, 98%) with a mean (SD) of 2.2 (0.6) g/day for 5.2 (3) days on average. The four patients who did not take acetaminophen also refused all other analgesics during their hospitalization. Ketoprofen was used by 38/162 (23%) patients with a mean (SD) of 83 (32) mg/day for 3.1 (1.9) days on average. Nefopam was used by 98/162 (60%) patients with a mean (SD) of 29 (11) mg/day for 2.5 (1.6) days on average. Tramadol was used by 58/162 (36%) patients with a mean (SD) of 82 (40) mg/day for 3.2 (2.1) days on average. Morphine was used by 16/162 (9.9%) patients with a mean (SD) of 13 (6) MME/day for 2.1 (2.5) days on average. Table 3 presents the modalities of analgesic consumption according to the postoperative complication. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Analgesic consumption in patients with or without postoperative complications.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"379\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.382585751978894%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eImmediate postoperative complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.59649122807018%\"\u003e\n \u003cp\u003eNo, N = 123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.8421052631579%\"\u003e\n \u003cp\u003eYes, N = 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.56140350877193%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcetaminophen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e119 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e39 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e4.5 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e7.4 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake per day (g/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e2.1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e2.3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e10 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e18 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetoprofen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e28 (23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e10 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e2.9 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e3.4 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e78 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e97 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e248 (210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e378 (279)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNefopam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e71 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e27 (69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e2.4 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e2.9 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e28 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e31 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e69 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e99 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e43 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e15 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e2.9 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e4 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e82 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e83 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e259 (248)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e353 (284)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMorphine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e9 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e7 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e1.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e2.9 (3. 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake per day (MME/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e12 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e14 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.84168865435356%\"\u003e\n \u003cp\u003e- total intake (MME)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.218997361477573%\"\u003e\n \u003cp\u003e20 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.16358839050132%\"\u003e\n \u003cp\u003e53 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.775725593667547%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statistics for continuous variable are presented by mean (SD)\u003c/p\u003e\n\u003cp\u003eMME, Morphine milligram equivalent; NS, not significant\u003c/p\u003e\n\u003cp\u003eThe bowel procedure had an impact on the quantity of acetaminophen consumed per day with 2 (0.5) g/day for colorectal shaving, 2.1 (0.6) for discoid resection, and 2.4 (0.6) for segmental resection (p=10\u0026shy;\u003csup\u003e-3\u003c/sup\u003e). It also impacted the consumption of nefopam with, respectively, 25 (7), 30 (14), and 31 (11) mg per day (p=0.03). On the other hand, no impact on ketoprofen (p=0.6), tramadol (p=0.5) or morphine (p=0.6) use was noted between patients with and without postoperative complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 shows the consumption of analgesics for the robotic and conventional groups. Among the tramadol users, more tramadol was consumed in the robotic group than in the conventional group (322 (222) mg vs 242 (292) mg, p=0.04)), with a tendency for longer use in the robotic group (3.7 (2.2) vs 2.7 (1.9) days, p=0.08)). There was no difference in the average daily dose received (p=0.2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Analgesic consumption in patients depending on the surgical route.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"528\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.053030303030305%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical route\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.25396825396825%\"\u003e\n \u003cp\u003eStandard Laparoscopy,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.96825396825397%\"\u003e\n \u003cp\u003eRobotic surgery,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.25396825396825%\"\u003e\n \u003cp\u003eN = 73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.96825396825397%\"\u003e\n \u003cp\u003eN = 89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.77777777777778%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcetaminophen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e72 (99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e86 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e5.1 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e5.2 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake per day (g/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e2.1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e2.2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e11 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e12 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetoprofen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e16 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e22 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e3.5 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e2.8 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e89 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e79 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e346 (288)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e243 (188)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNefopam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e39 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e59 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e2.8 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e2.3 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e31 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e28 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e88 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e69 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTramadol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e28 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e30 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e2.7 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e3.7 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake per day (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e78 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e86 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e242 (292)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e322 (222)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMorphine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e8 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e8 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- duration of use (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e1.7 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e2.4 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake per day (MME/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e14 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e11.7 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.34090909090909%\"\u003e\n \u003cp\u003e- total intake (MME)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.78787878787879%\"\u003e\n \u003cp\u003e27 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.265151515151516%\"\u003e\n \u003cp\u003e42 (83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.606060606060606%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statistics for continuous variable are presented by mean (SD)\u003c/p\u003e\n\u003cp\u003eMME, Morphine milligram equivalent; NS, not significant\u003c/p\u003e\n\u003cp\u003eAnalgesic consumption varied significantly according to the year of surgery. Figure 1 shows the changes in consumption of the different analgesics according to the year.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients consuming ketoprofen were more likely to use nefopam and tramadol \u0026nbsp; \u0026nbsp; (p=10\u003csup\u003e-3\u003c/sup\u003e), whereas patients consuming tramadol were more likely to use morphine (p=0.02).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFactors associated with an increased risk of opioid \u0026nbsp; use\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUnivariable and multivariable linear regression analysis of the consumption of any opioid is presented in Table 5. A history of abdominal surgery (OR=0.37 (0.16-0.78, p=0.011)), and undergoing surgery in 2020 rather than in 2019 (OR=0.10 (0.04-0.24, p\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e)), and in 2021 rather than in 2019 (OR= 0.08 (0.03-0.20, p\u0026lt;10\u003csup\u003e-3\u003c/sup\u003e)) were the only variables independently associated with the risk of opioid use after colorectal surgery for endometriosis. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5: Univariable and multivariable analysis on the consumption of any opioid\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"700\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eOpioid consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003eOR (univariable)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003eOR (multivariable)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e35.8 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e35.5 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e0.99 (0.95-1.04, p=0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eBMI (kg.m\u003csup\u003e-2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e25.0 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e24.9 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e1.00 (0.94-1.05, p=0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eHistory of abdominal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e52 (63.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e30 (36.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.55 (0.29-1.02, p=0.06)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.37 (0.16-0.78, p=0.01)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eYear of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\" rowspan=\"2\"\u003e\n \u003cp\u003e20 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\" rowspan=\"2\"\u003e\n \u003cp\u003e51 (71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003e-2019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003e-2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e38 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e11 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.11 (0.05-0.26, p\u0026lt;0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.10 (0.04-0.24, p\u0026lt;0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003e-2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e33 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.11 (0.04-0.25, p\u0026lt;0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.08 (0.03-0.20, p\u0026lt;0.001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eRobotic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e51 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e38 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e0.90 (0.48-1.69, p=0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eASRM score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e30.3 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e28.1 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e0.99 (0.97-1.01, p=0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eColorectal endometriosis surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\" rowspan=\"2\"\u003e\n \u003cp\u003e27 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\" rowspan=\"2\"\u003e\n \u003cp\u003e19 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\" rowspan=\"2\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\" rowspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003e- Shaving\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003e- Discoid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e34 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e24 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e1.00 (0.46-2.21, p=0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003e- Segmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e30 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e28 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e1.33 (0.61-2.92, p=0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e231.4 (82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e231.6 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e1.00 (1.00-1.00, p=0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eSuprapubic laparotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e29 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e26 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e0.81 (0.42-1.56, p=0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.180257510729614%\"\u003e\n \u003cp\u003eImmediate postoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e18 (50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.160228898426324%\"\u003e\n \u003cp\u003e21 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.70 (0.83-3.55, p=0.15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.74964234620887%\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eASRM, American society of reproductive medicine; SD, standard deviation; BMI, body mass index\u003c/p\u003e\n\u003cp\u003e*Statistics for continuous variable are presented by mean (SD)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe objective of this study was to present the postoperative analgesic consumption of patients operated on in an expert center for colorectal endometriosis. We observed that surgical procedure did not impact opioid consumption. However, during the period a shift in analgesic use was note with an increased consumption of anti-inflammatory drugs and nefopam while tramadol consumption was divided by 10 in 3 years. \u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, this is the first study to evaluate the modalities of consumption of postoperative analgesics in a large cohort of women operated on for colorectal endometriosis. As previously described, this is a challenging setting because colorectal endometriosis represents the most severe form of endometriosis and is the source of the most severe postoperative complications (16,17). Our complication rate is in agreement with previous reports: 13% of Clavien-Dindo grade IIIA, 8% grade IIIB, and 5% of grade IV (18). This relatively high complication rate can be explained by the incidence of some surgical risk factors such as a high rate of colpectomy, temporary diverting stoma, intra-operative JJ stent use, and ureteral or bladder resection (19,20). Moreover, as previously published for bowel cancer surgery, the high incidence of drainage in our series was associated with a risk of postoperative complications underlining the need to avoid systematic drainage (21,22). In our study, the surgical approach \u0026ndash;robotic or conventional laparoscopy\u0026ndash; had no impact on the likelihood of being exposed to an opioid during hospitalization. However, in patients using tramadol preoperatively, robotic surgery increased the total amount consumed linked to longer postoperative use. Our results are partially in agreement with those of previous studies showing no difference in analgesic consumption between robotic vs conventional laparoscopy (9). However, our data contrast with the results of Mangalath et al (23) reporting lower analgesic use during the first postoperative 24 hours following robotic surgery. This apparent discrepancy can be explained by the limited sample size of Mangalath et al\u0026rsquo;s study which only included 24 patients in the robotic group, after exclusion of four, and 24 patients in the laparoscopic group, after exclusion of 37. \u003c/p\u003e\n\u003cp\u003eBeyond the surgical approach, postoperative analgesic consumption should be analyzed in the specific context of endometriosis. Time-to-diagnosis for patients with endometriosis can be as long as 12 years during which time they often experience considerable pain (1). They have often been subjected to medical wandering and multiple surgeries, and can suffer from anxiety and depressive disorders (24), all of which have a negative impact on social and familial relationships as well as causing stigma. This explains the high preoperative incidence of analgesic consumption in this population (25). Our data focus on the in-hospital postoperative period and only on drugs that were both prescribed and actually taken by the patients. The first 2 days after colorectal surgery are the most painful (26), and this therefore represents a crucial moment for analgesic consumption: the likelihood of chronic opioid use increases with each additional day of medication supplied starting with the third day after surgery (27). In our study, the average duration was 2.06 days (2.09) for morphine consumption and 3.22 (2.09) days for tramadol for a mean hospital stay of 1 week. This means that very few patients were using opioids by the end of their hospital stay, and that there is no need to prescribe them at discharge.\u003c/p\u003e\n\u003cp\u003eThis study also showed that it was possible to radically change the prescription habits of all the practitioners working in our center. The example of tramadol is the most striking. Tramadol is a strong contributor to the risk of future opioid addiction (27) and was the first opioid analgesic cited in a 2018 survey of problematic use both among substance abusers and in the general population for pain management conducted by the French National Drug Safety Agency and published in February 2019 (28). Problematic use included dependence with signs of withdrawal occurring even when taken at recommended doses and over a short period of time, and leading to persistent intake by patients who no longer experience pain. The report highlighted that tramadol was also the first analgesic involved in deaths related to the use of analgesics, ahead of morphine. Following this report and recommendations to restrict the indications for tramadol prescription, we have been able to divide its consumption in our hospital by a factor of 10 in 3 years.\u003c/p\u003e\n\u003cp\u003eOpioid treatments have been replaced by the non-steroid anti-inflammatory drugs (NSAID) ketoprofen and nefopam. By 2021, two out of three patients were receiving ketoprofen in postoperative care and three out of four nefopam. Nefopam has been shown to be effective postoperatively (29) and to reduce opioid consumption when combined with an NSAID (30). NSAIDs should be the weapon of choice in postoperative prescriptions: they are effective postoperatively and reduce opioid consumption (31), but they also reduce the rate of fistulas after colorectal surgery (32,33) and shorten the time required to resume transit (34,35). However, as we have seen, there is still room for improvement to increase the prescription of NSAIDs during the postoperative in-hospital period in our department. In our study, in addition to the year of surgery, prior surgery was also found to represent a risk of opioid consumption. This is probably because the patient was exposed to opioids during their previous hospitalization and wishes to benefit from their analgesic effects again. Special attention should thus be paid to patients with a history of surgery, as can often be the case in endometriosis. \u003c/p\u003e\n\u003cp\u003eFinally, although neither the digestive procedure performed nor on the severity of the disease impact postoperative opioid consumption, preoperative consumption has been shown to be a major factor in its use postoperatively (36). This is the main limitation of the study: we did not collect the patients\u0026apos; preoperative consumption habits and a future study will have to take this bias into account. Similarly, we did not collect data about the duration and type of analgesics used after hospitalization, which is important information regarding the risk of chronic opioid use. Finally, the retrospective nature of the data always represents a bias although we used a software dedicated to the prescription of analgesics allowing a comprehensive evaluation of drug consumption. \u003c/p\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eIn conclusion, our study presents rare data on the immediate postoperative consumption of patients having undergone surgery for colorectal endometriosis. We were able to demonstrate that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in these patients. Furthermore, our study shows that it is possible to rapidly modify in-hospital analgesic consumption by significantly reducing opioid consumption in favor of NSAIDs or nefopam.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding:\u0026nbsp;No funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003eConflicts of interest: The authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmine Bibaoune, Marjolaine Le Gac and Yohann Dabi participated in the data collection, Adrien Crestani carried out the statistics; Kamila Kolanska, Cl\u0026eacute;ment Ferrier and Sofiane Bendifallah participated in the writing of the article; Emile Darai validated the final version. Each author ead the manuscript and approved its submission.\u003c/p\u003e\n\u003cp\u003eConsent to participate:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInformation consent was obtained from all individual participants included in the study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;No funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003eConflicts of interest: The authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020;382(13):1244\u0026ndash;56. \u003c/li\u003e\n\u003cli\u003eWeaver J, Chakladar S, Mirchandani K, Liu Z. Surgical and Pharmacological Treatment Patterns in Women with Endometriosis: A Descriptive Analysis of Insurance Claims. J Womens Health (Larchmt) 2022;31(7):1003\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eLamvu G, Soliman AM, Manthena SR, Gordon K, Knight J, Taylor HS. Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines. Obstet Gynecol 2019;133(6):1120\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eAs-Sanie S, Soliman AM, Evans K, Erpelding N, Lanier RK, Katz NP. Short-acting and Long-acting Opioids Utilization among Women Diagnosed with Endometriosis in the United States: A Population-based Claims Study. Journal of Minimally Invasive Gynecology 2021;28(2):297-306.e2. \u003c/li\u003e\n\u003cli\u003eZhang W, Miller V, Wong M, Loring M, Morris S. Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy. JSLS 2022;26(3):e2022.00028. \u003c/li\u003e\n\u003cli\u003eDelgado SI, Koythong T, Turrentine MA, Sangi-Haghpeykar H, Guan X. Postoperative opioid use for patients with chronic pelvic pain undergoing robotic surgery for resection of endometriosis. J Robotic Surg 2022;16(2):421\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eHill MV, McMahon ML, Stucke RS, Barth RJJ. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Annals of Surgery 2017;265(4):709\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eLovich-Sapola J, Smith CE, Brandt CP. Postoperative Pain Control. Surgical Clinics of North America 2015;95(2):301\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eMoawad GN, Klebanoff JS, Muldoon O, North A, Amdur R, Tyan P. Patterns of narcotic utilization in women undergoing hysterectomy for benign indications. Journal of Gynecology Obstetrics and Human Reproduction 2021;50(9):102181. \u003c/li\u003e\n\u003cli\u003eBazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 2004;232(2):379\u0026ndash;89. \u003c/li\u003e\n\u003cli\u003eRoseau G. Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis. World J Gastrointest Endosc 2014;6(11):525\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eBazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004;24(2):180\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eDara\u0026iuml; E, Ballester M, Chereau E, Coutant C, Rouzier R, Wafo E. Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis. Surg Endosc 2010;24(12):3060\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eCalculating Total Daily Dose of Opioids For Safer Dosage. :2. \u003c/li\u003e\n\u003cli\u003eClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eBalla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018;33(7):835\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eBendifallah S, Puchar A, Vesale E, Moawad G, Dara\u0026iuml; E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021;28(3):453\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eFerrier C, Le Gac M, Kolanska K, Boudy A-S, Dabi Y, Touboul C, et al. Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: A prospective cohort study. Int J Med Robot 2022;18(3):e2382. \u003c/li\u003e\n\u003cli\u003eZilberman S, Ballester M, Touboul C, Ch\u0026eacute;reau E, S\u0026egrave;be P, Bazot M, et al. Partial Colpectomy is a Risk Factor for Urologic Complications of Colorectal Resection for Endometriosis. Journal of Minimally Invasive Gynecology 2013;20(1):49\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eBallester M, Belghiti J, Zilberman S, Thomin A, Bonneau C, Bazot M, et al. Surgical and clinical impact of extraserosal pelvic fascia removal in segmental colorectal resection for endometriosis. J Minim Invasive Gynecol 2014;21(6):1041\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS\u0026reg;) Society Recommendations: 2018. World J Surg 2019;43(3):659\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003ePodda M, Saverio SD, Davies RJ, Atzeni J, Balestra F, Virdis F, et al. Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials. The American Journal of Surgery 2020;219(1):164\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eMangalath AS, Kumar L, Sawant AB, Kesavan R, Ravindran G, Sunil R. Comparison of analgesic requirements in robot-assisted versus conventional laparoscopic abdominal surgeries. J Anaesthesiol Clin Pharmacol 2021;37(1):79\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eJin J, Chen Q, Min S, Du X, Zhang D, Qin P. Prevalence and predictors of chronic postsurgical pain after colorectal surgery: A prospective study. Colorectal Disease 2021;23(7):1878\u0026ndash;89. \u003c/li\u003e\n\u003cli\u003eLagan\u0026agrave; AS, Rosa VLL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B, et al. Anxiety and depression in patients with endometriosis: impact and management challenges. IJWH 2017;9:323\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eLindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis 2020;35(7):1265\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eShah A. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use \u0026mdash; United States, 2006\u0026ndash;2015. MMWR Morb Mortal Wkly Rep [Internet] 2017 [cited 2022 Dec 10];66. Available from: https://www.facebook.com/CDCMMWR\u003c/li\u003e\n\u003cli\u003eUse and abuse of opioid analgesics - February 2019. :52. \u003c/li\u003e\n\u003cli\u003eEvans MS, Lysakowski C, Tram\u0026egrave;r MR. Nefopam for the prevention of postoperative pain: quantitative systematic review. British Journal of Anaesthesia 2008;101(5):610\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMoffat AC, Kenny GN, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery. Anaesthesia 1990;45(4):302\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eWick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg 2017;152(7):691\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGrahn O, Lundin M, Chapman SJ, Ruteg\u0026aring;rd J, Matthiessen P, Ruteg\u0026aring;rd M. Postoperative nonsteroidal anti-inflammatory drugs in relation to recurrence, survival and anastomotic leakage after surgery for colorectal cancer. Colorectal Disease 2022;24(8):933\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eKverneng Hultberg D, Angenete E, Lydrup M-L, Ruteg\u0026aring;rd J, Matthiessen P, Ruteg\u0026aring;rd M. Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer. Eur J Surg Oncol 2017;43(10):1908\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eMilne TGE, Jaung R, O\u0026rsquo;Grady G, Bissett IP. Nonsteroidal anti-inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 2018;20(8):O190\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGupta A, Bah M. NSAIDs in the Treatment of Postoperative Pain. Curr Pain Headache Rep 2016;20(11):62. \u003c/li\u003e\n\u003cli\u003eKanellos P, Nirgianakis K, Siegenthaler F, Vetter C, Mueller MD, Imboden S. Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis. J Clin Med 2021;10(20):4727. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Endometriosis, colorectal surgery, post-operative pain, analgesic consumption, opioids","lastPublishedDoi":"10.21203/rs.3.rs-2981972/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2981972/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe aim of this study was to analyze postoperative consumption of analgesics during hospitalization following colorectal surgery for endometriosis.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective study at Tenon University Hospital, Paris, France from February 2019 to December 2021.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOne hundred sixty-two patients underwent colorectal surgery: 89 (55%) by robotic and 73 (45%) by conventional laparoscopy. The type of procedure had an impact on acetaminophen and nefopam consumed per day: consumption for colorectal shaving, discoid resection and segmental resection was, respectively, 2(0.5), 2.1(0.6), 2.4(0.6) g/day (p\u0026thinsp;=\u0026thinsp;10\u0026thinsp;\u0026minus;\u0026thinsp;3), and 25(7), 30(14), 31(11) mg/day (p\u0026thinsp;=\u0026thinsp;0.03). The total amount of tramadol consumed was greater following robotic surgery compared with conventional laparoscopy (322(222) mg vs 242(292) mg, p\u0026thinsp;=\u0026thinsp;0.04). We observed a switch in analgesic consumption over the years: tramadol was used by 70% of patients in 2019 but only by 7.1% in 2021 (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026thinsp;\u0026minus;\u0026thinsp;3); conversely, ketoprofen was not used in 2019, but was consumed by 57% of patients in 2021 (p\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026thinsp;\u0026minus;\u0026thinsp;3). A history of abdominal surgery (OR\u0026thinsp;=\u0026thinsp;0.37 (0.16\u0026ndash;0.78, p\u0026thinsp;=\u0026thinsp;0.011) and having surgery in 2020 rather than in 2019 (OR\u0026thinsp;=\u0026thinsp;0.10 (0.04\u0026ndash;0.24, p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e)) and in 2021 than in 2019 (OR\u0026thinsp;=\u0026thinsp;0.08 (0.03\u0026ndash;0.20, p\u0026thinsp;\u0026lt;\u0026thinsp;10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003e)) were the only variables independently associated with the risk of opioid use.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWe found that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in this setting, and that it was possible to rapidly modify in-hospital analgesic consumption modalities by significantly reducing opioid consumption in favor of NSAIDS or Nefopam.\u003c/p\u003e","manuscriptTitle":"Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-30 14:53:31","doi":"10.21203/rs.3.rs-2981972/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-07-09T12:43:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-07-09T10:58:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4bbcc384-e6ae-4cf3-b44a-4ccce62c6ef8","date":"2023-06-25T15:34:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b5d6d365-03c4-43de-b26e-89555bb0cb47","date":"2023-06-04T18:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9b1690cd-afec-4b78-a12e-17b1af2fc711","date":"2023-06-01T16:43:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-06-01T16:29:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-05-28T17:48:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-05-26T08:20:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2023-05-25T15:20:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fdfeb580-5f2b-4616-a618-d998799ad34f","owner":[],"postedDate":"May 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:05:42+00:00","versionOfRecord":{"articleIdentity":"rs-2981972","link":"https://doi.org/10.1007/s11701-023-01691-y","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2023-08-22 15:02:19","publishedOnDateReadable":"August 22nd, 2023"},"versionCreatedAt":"2023-05-30 14:53:31","video":"","vorDoi":"10.1007/s11701-023-01691-y","vorDoiUrl":"https://doi.org/10.1007/s11701-023-01691-y","workflowStages":[]},"version":"v1","identity":"rs-2981972","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2981972","identity":"rs-2981972","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}